Treatments for Patients

Qu.1 The patient has a compound fracture of the lower leg, with bleeding and soft tissue damage. Neurological assessment should be made distal to the break to check for nerve damage. Blood loss should be estimated from visible bleeding and degree of swelling of the broken limb. Care should be taken when moving the patient to avoid further injury to the limb or damage to nerves.

Qu.2 The patient will need antibiotics to prevent infection, and careful attention should be paid to cleaning the wound area. The wound area should be kept covered with a light dressing which will prevent infection from airborne microbes without putting any pressure on the wound. A frame may be placed over the leg so that the bed sheet does not actually touch the leg. The leg should be kept immobilized until more permanent immobilization is achieved through a cast or a splint.

Qu.3 Russell's traction is composed of Buck's extension

on the lower leg using the Buck's boot (Skin, 2003). Nurses must inspect the traction equipment every shift to ensure traction cords are aligned in each pulley; cords are not stretched or frayed; knots are tied tightly and secured with tape; cords are hanging free of the bed and floor; weights are hanging free of the bed and floor; the correct amounts of weight are hanging; spreaders, foot plates, splints are not touching the bed; and the bed linen is not interfering with the line of traction. Correct body alignment must be maintained and proper bed po

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thed by using a sponge bath technique. The skin should be checked beneath the cast edges morning and evening for skin irritation, redness, blistering, open or draining areas, or pressure spots (Hip, 2004). Casts can also cause pressure ulcers, thermal burns during hardening, and thrombophlebitis, and these should be checked for (Buckley and Arneja, 2004). Prolonged cast immobilization can cause circulatory disturbances, inflammation, bone disease, chronic edema, soft tissue atrophy and joint stiffness. These issues should be addressed in nursing aftercare. The cast should be observed for cracks, softening, increasing tightness or looseness, or drainage on the cast (Hip, 2004). The child must be positioned properly and turned regularly to provide maximum comfort. Heels and toes should be free of pressure when touching the bed. Open reduction and internal fixation (ORIF) refers to surgically repairing a fractured bone, and generally involves either the use of plates and screws or an intramedullary rod to stabilize the bone (Cluett, 2004). Care involves the prevention of infection while the fracture heals by establishing hemostasis and administering antibiotics (Buckley and Srneja,2004). Cefazolin is adequate for type I

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